Chronic leg swelling can be uncomfortable and embarrassing, affecting your physical movement and participation in everyday activities. Together with disfigurement of the legs, such swelling can indicate an underlying condition known as lymphedema.

In this article, we will explore the causes and symptoms of lymphedema before covering treatment options.

What is lymphedema?

Lymphedema is a medical condition characterised by the abnormal accumulation of lymphatic fluid in the tissues, causing swelling, most frequently in the arms and legs. 

The lymphatic system, consisting of lymph nodes, lymph vessels, and lymph fluid, is part of the circulatory and immune systems. It helps remove waste, toxins, and excess fluid from the body's tissues.

A compromised lymphatic system may result in lymphedema. The condition is categorised into two types: primary and secondary.

Primary lymphedema

Primary lymphedema is a rare condition resulting from congenital or hereditary abnormalities in the lymphatic system. Although it can develop at any age, it commonly presents in infancy, adolescence, or early adulthood.

Causes

The causes of primary lymphedema are generally genetic and may include:

1. Congenital malformations: Some individuals are born with an underdeveloped or malformed lymphatic system. This congenital anomaly can hinder the proper drainage of lymph fluid, leading to lymphedema at birth or later in life.
2. Genetic mutations: Some genetic mutations are linked to primary lymphedema. For example, Milroy disease is a hereditary condition caused by mutations in the FLT4 gene, leading to lymphedema that typically manifests in infancy. Meige disease, another form of primary lymphedema, usually presents around puberty and is associated with different genetic factors.
3. Familial history: People with a family history of lymphedema have a higher risk of developing the condition, suggesting a strong genetic component in primary lymphedema cases.

Secondary lymphedema

Secondary lymphedema is more prevalent than primary lymphedema. It occurs when there is damage to the lymphatic system from an external factor. This damage can lead to blockage or disruption of lymphatic flow, resulting in fluid accumulation and swelling.

Causes

The causes of secondary lymphedema are often related to trauma, surgery, or other medical conditions, including:

1. Surgery: Surgical procedures that involve lymph node removal or damage to lymph vessels can result in secondary lymphedema. Secondary lymphedema is common in surgeries related to cancer treatment, such as mastectomies with lymph node dissection or surgeries involving the removal of tumours that are close to lymphatic tissues.
2. Radiation therapy: Radiation treatment for cancer can scar and damage the lymph nodes and vessels, leading to the development of lymphedema months or even years after the initial treatment.
3. Infection: Certain infections, especially those that affect the lymphatic system, can cause secondary lymphedema. Infections such as cellulitis or lymphangitis can damage the lymphatic vessels, leading to impaired drainage of lymph fluid.
4. Trauma or injury: Accidents or injuries that damage the lymphatic system can lead to lymphedema. These accidents could include blunt force trauma or cuts that affect the lymph nodes or vessels.
5. Cancer: Tumours that block lymphatic vessels or invade lymph nodes can obstruct lymphatic flow, resulting in secondary lymphedema. This is often seen in cases of lymphoma or metastatic cancers.

Symptoms of lymphedema

The symptoms of lymphedema can vary in severity, depending on the stage of the condition and the individual. Common symptoms include:

• Swelling: The most recognisable symptom of lymphedema is swelling in the legs, which may range from mild to severe. The swelling usually affects one leg but can occur in both. The swelling can fluctuate throughout the day, often worsening as the day progresses or after prolonged standing or sitting.
• Heaviness and tightness: People with lymphedema often experience heaviness or tightness in the affected limb, which can be uncomfortable and restrict movement.
• Pain and discomfort: Lymphedema can cause pain, aching, or feeling fullness in the affected area. The pain can be bearable or severe, and can impact daily activities.
• Skin changes: The skin overlying the swollen area may become thickened, hardened, or fibrotic (a condition known as fibrosis). Additionally, the skin may appear red and warm and feel tighter than usual.
• Recurring infections: Individuals with lymphedema are more susceptible to skin infections, such as cellulitis, due to impaired lymphatic drainage. Recurrent infections can exacerbate the condition and lead to further complications.
• Reduced range of motion: Swelling and discomfort can reduce flexibility and movement in the affected limb, making it difficult to perform daily tasks.

Treatment and management

While lymphedema is a chronic condition, various treatments and management strategies can help alleviate symptoms, reduce swelling, and improve your quality of life. These include:

1. Compression therapy: Compression garments are often used to help reduce swelling by promoting lymphatic fluid drainage from the affected limb. These garments provide controlled pressure, encouraging lymph fluid movement and preventing further accumulation.
2. Manual Lymphatic Drainage (MLD): This specialised massage technique aids the flow of lymph fluid and reduces swelling.
3. Exercise: Regular physical activity, especially exercises that promote limb movement and muscle contraction, can help improve lymphatic circulation and reduce swelling. Low-impact activities like walking, swimming, and cycling are often recommended.
4. Skincare: Proper skincare is crucial for individuals with lymphedema to prevent infections and complications. Keeping the skin clean, moisturised, and protected from injury can help reduce the risk of skin infections, such as cellulitis.
5. Surgery: In severe cases of lymphedema, surgical interventions may be considered. Procedures such as lymph node transfer or bypass surgery can help improve lymphatic drainage and reduce swelling.
6. Pneumatic compression devices: These devices use inflatable sleeves to apply intermittent pressure to the affected limb, encouraging lymph fluid movement and reducing swelling. They can be used at home in a comprehensive lymphedema management plan.
7. Lifestyle modifications: Keeping to a healthy weight, avoiding prolonged standing or sitting, and elevating the affected limb when resting can help manage lymphedema symptoms effectively.

Lymphedema treatment in Singapore

Whether dealing with primary or secondary lymphedema, getting appropriate medical care is crucial to improving your quality of life.

Polaris Plastic and Reconstructive Surgery offers specialised treatment for individuals with lymphedema of the legs. Our experienced professionals in Singapore provide personalised care, focusing on both surgical and non-surgical approaches to manage lymphedema effectively.

If you are showing symptoms of lymphedema, book an appointment for treatment today.